| NPI | 1053790238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020166) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME TP15056) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2020-08-24 |